Nutrition, Growth,

and Early Child Development

Maureen Black, Ph.D.

University of Maryland

RTI, Consultant

BRAIN DEVELOPMENT

• 100 billion neurons

• 60 trillion synapses

• 3 pounds

• How does it develop?

3

• 89 billion neurons

• 60 trillion synapses

• 3 pounds

• Adult size – age 6

Fetus Late Infancy/Toddler Pubertal

Developmental Perspective

Thompson & Nelson, 2000

1000 days

Fetus Late Infancy/Toddler Pubertal

Developmental Perspective

Thompson & Nelson, 2000

1000 days

Second 1000 days(age 2-5 years)

Gap in opportunities(child care)

WHO MULTICENTRE GROWTH Mean length of children age <24 mos

Children throughout the world grow similarly when their health care needs are met.

Worldwide timing of growth faltering from 54 countries

Victora et al. Pediatrics 2010;125:e473-e480

1000 days

Stunting occurs prenatally and before age 2

WASTING & STUNTING IN CHILDREN

BRAIN DEVELOPMENT

Early Stunting: Negative

Consequences for Learning

• Based on Poverty and Stunting:

• 219 million children (39%) < age 5 in low and middle income countries do not reach their developmental potential

• 19.8% deficit in adult annual income, largely attributed to schooling losses

Lancet series on child development, 2007, 2011, 2016

Countries With High Burden of

Malnutrition

These 34 countries account for 90% of the global burden of malnutrition

Global prevalence and numbers of

stunting and underweight 1990-2015

children < age 5

Globally, 24% of children <

age 5 years are stunted or

165,000,000 children.

Sub-Saharan Africa, Asia

STUNTING IN UGANDA

WHEN TO INVEST IN CHILD

DEVELOPMENT:

NUTRITION/CAREGIVING

Mother

Pre-conception

Prenatal

Child

Breast feeding

Complementary feeding

Responsive Caregiving

Storytelling

Play/Exploration

Early Learning

CONCEPTUAL FRAMEWORK:

EARLY CHILD DEVELOPMENT

.Brain

Development/ Functioning

Motor

Social Emotional

Growth

Cognitive Language

CONCEPTUAL FRAMEWORK:

EARLY CHILD DEVELOPMENT

.

Biological Factors

Brain Development/

Functioning

Motor

Social Emotional

Growth

Cognitive Language

CONCEPTUAL FRAMEWORK:

EARLY CHILD DEVELOPMENT

.

Socio-cultural

PovertyBiological

Factors

Brain Development/

Functioning

Motor

Social Emotional

Growth

Cognitive Language

CONCEPTUAL FRAMEWORK:

EARLY CHILD DEVELOPMENT

.

Socio-cultural

Poverty

Caregiving Factors

Biological Factors

Brain Development/

Functioning

Motor

Social Emotional

Growth

Cognitive Language

CONCEPTUAL FRAMEWORK:

EARLY CHILD DEVELOPMENT

.

Socio-cultural

Poverty

Caregiving Factors

Biological Factors

Brain Development/

Functioning

Motor

Social Emotional

Growth

Cognitive Language

Early learning opportunitiesResponsive caregiving

CONCEPTUAL FRAMEWORK:

EARLY CHILD DEVELOPMENT

.

Socio-cultural

Poverty

Caregiving Factors

Biological Factors

Brain Development/

Functioning

Motor

Social Emotional

Growth

Cognitive Language

Early learning opportunitiesResponsive caregiving

INTEGRATE NUTRITION &

PARENTING INTERVENTIONS (0-3)

• Home visits, guidance and support from health providers, and group parent training

• Impacts are larger when:

– parents and children participate together

– interventions involve modeling and practice of behavior

– most disadvantaged children targeted

Lancet series on child development, 2007, 2011

BOOKS & STORY TELLING

Vally Z et al., J of Child Psychology & Psychiatry, 2015

INTEGRATE NUTRITION & PRESCHOOL

INTERVENTIONS (3-5 yrs)

• Preschools improve children's cognitive & social-emotional development: school readiness

• Impact is greatest with high quality programs– Teacher-student ratio

– Developmental curriculum

– Student exploration

– Teacher responsivity

Lancet series on child development, 2007, 2011

Building blocks of adult health, earnings, & well-being occur in early child development

Campbell Science 2014 Gertler Science 2014

North Carolina35 years

Beneficial effects on blood pressure,

metabolic syndrome

Jamaica 25 years

Beneficial effects on wages

reduction in violence

LIFE COURSE PERSPECTIVE

TO CHILD DEVELOPMENT

Birth

Early Childhood

Childhood

Adolescence

Conception

Healthy nutrition and learning opportunities throughout life

GLOBAL GOALS

193 countries endorsed Early Childhood Development as the transformative solution

THANK YOU

27

Gender and Girls’ Education

Sustainable Development Goal 4:

• By 2030, ensure that all girls and boys complete free, equitable and quality primary and secondary education leading to relevant and effective learning outcomes

• ‘Leave no one behind’

yg

Closing the gender gap in schools: one of the biggest education successes since 2000

52 million fewer girls out of school

© UNICEF/NYHQ2015-2131/Grile

No country in sub-Saharan Africa has achieved gender parity in both primary and secondary education

In Africa16.7 million girls are out of school in the region, 9.3 million of which will never set foot in a classroom

© UNICEF/NYHQ2015-0770/Bindra

In Sub-Saharan Africa, 75 percent of girls start primary school but only 8 percent finish secondary school

Staying in and completing

school remains a challenge

Poorest girls are being

left behind

Rural students, especially girls are further behind

Gender discrimination holds girls

back

• Child Marriage

• Early pregnancy

• SRGBV

• Household work

Ugandan adolescent girls

still at risk

2/3 of all new HIV

Infections58%

suffered sexual

violence

1 in 4 girls is married

1 in 4 girls has at least 1 child

What works for girls?

Considerations for Uganda

• Address costs especially for rural girls – Ensure education must be free – really free

• Make every year count –– Start on time; target transitions

• Focus on adolescent girls and their issues; – Work to eliminate child marriage, reduce early

pregnancies and end SRGBV

• Support teachers to address gender inequality; build women education leaders

A journey toward

gender equality in education

Making Schooling More Meaningful: The

benefits of learning to read in mother

tongue in the early grades

The Issues

• Statistics of low literacy (reading) achievement

among of primary school learners

• Evident causes of low levels, with reference to

home and schooling experiences

• Available solutions, emphasizing mother tongue

reading and writing programs in lower grades

• Evidence of gains from systematic mother tongue

reading instruction demonstrated by SHRP

• How Government can institutionalize these gains

The Problem

• NAPE data (2014) of 64.2% of P3 learners being

proficient in English literacy and 48.6% in oral reading.

• UWEZO data (2013) of 47% of 10 year olds in Uganda

reading.

• School Health and Reading Program EGRA data (2013)

shows low abilities ranging between 0 and 0.3 wpm

among P1 children for Atɛsͻ, Lëblaŋo, Luganda and

Runy-Ruk.

• Statistics suggest learning failure, given the critical role

of reading in learning.

• Statistics are in spite of the Thematic Curriculum which

emphasizes teaching in the child’s familiar language.

A Review of the Causes

• The Thematic Curriculum emphasizes the existing

speaking and listening competences of the child as a

basis for early reading and writing.

• Children come to school with a level of competence

in speaking and listening in mother tongue.

• Children joining P1 are exposed to content in an

unfamiliar language, and are expected to know how

to read in it.

• Few teachers are equipped with knowledge of how

children learn to read and the methods of teaching

reading in early grades.

• Children have had no print to read from in class.

Solution

• Learning to read in a familiar language strengthens

a child’s reading abilities which are transferable to

second and third language learning experiences.

• Teaching is effective only if done in a systematic

manner focusing on:

adequate instructional time

a familiar language

age and grade level appropriate texts

trained teachers and teacher support

continuous assessment of learners

Age and Grade Level Appropriate Text

in a Familiar Language

• developed on the basis of an orthography validated

by the speech community (language board is key)

• reflecting the five components of reading, so as to

build the foundational competences that are

transferable to other languages

• aligning content with the themes and sub-themes of

the TC so that children can draw on their real world

experiences, progressing from known to unknown

• incorporating the value of Oral Literature and News

for mastering listening, speaking, vocabulary,

structures and critical thinking

Benefits: Local Language Oral Reading Fluency

(wpm) Baseline March 2013 and Follow-up Oct 2014

(SHRP EGRA data)

0 1.9 0.1 2 0.2

9.2

0.3

6.9

0 0.5 0 0.9 0.1

5.5

0.3

4.4

Baseline Follow-up 2 Baseline Follow-up 2 Baseline Follow-up 2 Baseline Follow-up 2

Ateso Leblango Luganda Run/Rukiga

School Health and Reading Program

Control

Benefits: Percentage of Local Language

Comprehension Questions Answered - End of P2

(SHRP EGRA data)

1 1

3 3

0.2 0

2.5

0.4

Ateso Leblango Luganda Run/Rukiga

Local Language English

Benefits: Number of Reading Comprehension

Questions Answered Correctly – End of P2

(SHRP EGRA data)

Act to Institutionalize …

• EGR reading methodology, for teachers to change classroom practices - teach reading from print, emphasize the phonic approach, conduct continuous assessment;

• provision of adequate primers (1:1) and teachers’ guides;

• college based training of pre-service teachers in EGR reading methodology;

• classroom support for reading teachers, involving head teachers, CCTs, district education officers, and

• EGRA to scale.